Spinal Stenosis Treatment in Thailand

Surgery may be required if the patient needs to be urgently treated for spinal cord compression. The decision to go through surgery should be taken after much consideration and discussion with the doctor. The doctor should explain all the surgical alternatives to the patient. The type of surgery that is needed is dependent on the cause and location of the spinal stenosis.

How is Spinal Stenosis Treated?
There are various options available for the treatment of spinal stenosis. They include:

• Posture Change
  Patients can try and change their postures, which may relieve some symptoms. For instance, bending the spine forward while walking and drawing the knees up to the chest while lying down may provide relief. These postures create more space for the nerves, and patients find it easier to walk long distance.
• Medication
  Inflammation may cause severe pressure on the nerves. This can be treated by anti-inflammatory medications that are non-steroidal. Aspirin or ibuprofen may provide relief. Medication can also be used to control pain and reduce muscle spasm. It is best to consult a doctor before taking the medicines, which may also be available over-the-counter. Before using medication, the patient is advised to be aware of any side effects.
• Injections
  Epidural injections consisting of steroidal medication is applied into the epidural space around precise nerve roots. This helps in reducing swelling and severe pain that spreads into the limbs. The course consists of three injections that need to be taken over a period of many weeks. This may help in reducing the symptoms permanently or temporarily for some weeks or months. However, steroidal injections have some side effects, which include:
  
  • Severe pain at the injection site
  • High fever
  • Anxiety
  • Increase in weight
  • Insomnia
  • High blood sugar and pressure
  • Decreased immunity to fight against infection
  • Cataracts
  • Stomach ulcers
  • Avascular necrosis
    The doctor should be informed immediately if the following symptoms occur:
    
  • Loss of control over bladder and bowels
  • Instability of the legs
  • Painful headaches
• Physical Therapy
  Physical therapy that consists of inactive therapy and exercises help in increasing flexibility, and gaining strength and stamina. Inactive therapy uses application of heat and ice packs, massage, electrical stimulation, and ultrasound. This prepares the patient for physical exercises by reducing pain and relaxing muscles. Physical therapy exercises are usually stretching and other exercises that help in regaining the stability of the spine.
• Other Exercises
  The patient may consider walking and swimming to exercise all the back muscles. Swimming provides a secure environment and the water supports the patient's weight relieving pressure on the back.
• Surgery
  Surgery is recommended if all other treatments fail to control the pain and pressure on the nerves.
  There are two major types of surgical methods that are used to treat spinal stenosis - Decompression and Spinal Fusion:
  
  Decompression
  The tissue that causes pressure on a nerve is removed during decompression. This creates more space for the spinal cord or nerve roots. The following surgical methods are used to perform decompression:
  • Foraminotomy
    This is done if a portion of the disc or osteophyte causes pressure on a nerve that passes through the foramen. The foramen in made larger so that the nerve is not compressed.
  • Laminotomy
    This is done if the lamina causes pressure on a nerve. The opening on the lamina is made larger so that the nerve is not compressed.
  • Laminectomy
    When a laminotomy is inadequate to decompress a nerve, laminectomy needs to be performed. During laminectomy, the entire lamina or a part of it is removed.
  • Indirect Decompression
    Indirect decompression involves relieving pressure on the nerve by spreading the bones apart. To achieve this, devices like inter-body cages and artificial discs are used.
• Spinal Fusion
  Spinal fusion is also known as stabilization. It permanently fixes two vertebrae together. As a result there is no movement between these bones. Other surgical procedures such as laminectomy etc. are usually done prior to a spinal fusion. A graft is used to join the bones permanently together. If the graft is taken from another body part, commonly from the pelvic bone, it is called an autograft. The graft may also be taken from a bone bank known as allograft. In rare cases, synthetic bone substitutes may also be used. Screws, plates or cages are used to join the vertebrae together so that the bones do not move when they are healing.